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The advance of the coronavirus has expanded mainly in the Metropolitan Region (RM), concentrating more than 71% of the accumulated cases. During the last week, the first signs of saturation of the health system in the region have begun to emerge, mainly in the western area, where this Tuesday 100% of ICU beds were occupied. Despite the fact that currently there are more than 4 million people in quarantine, distributed in 25 communes, epidemiologists, health professionals and political authorities have raised the request that the quarantine be extended to practically the entire MR, with the exception of rural communes.
The Metropolitan Region concentrates more than 71% of the accumulated cases nationwide, with a total of 22,709 of 31,721. In Minsal’s latest daily report, it is noted that 83.9% of positive cases were registered on MRI, the equivalent of 1,392 people with COVID-19. Just a week ago, on May 5, the Metropolitan Region registered 978 new cases.
To this, a new critical point is added: the saturation of the system of laboratories that process PCR tests, an issue that puts in check the nerve center of the strategy against the coronavirus of Minister Jaime Mañalich, such as mass testing and dynamic quarantines.
In line with this strategy, the test of asymptomatic cases in specific places with COVID-19 outbreaks, such as prisons and residences for older adults, was added, plus the cases of people who had a direct relationship with a diagnosed person, a test that in their together they would correspond to 40% of the total PCR examinations carried out by the public sector, according to approximations that Minister Mañalich gave last week. Seven days later, the main defense against the spread of the virus begins to give serious signs of saturation, after a series of private venues announced during the day on Tuesday that they will suspend taking PCR tests until further notice, due to problems ” in technical capacity. “
The authorities have highlighted that during May Chile managed to double its testing capacity, reaching a total of 303,340 examinations reported by the network of laboratories, specialists estimate that more than half of them are concentrated in the Metropolitan Region. According to the May 2 Minsal report, laboratories in the Metropolitan Region reported that there were 1,145 new cases, equivalent to 80% of the cases registered in the country. The total number of PCR tests reported by the laboratory network for that day was 9,967 nationwide, of which 5,290 correspond to private laboratories, 4,141 to hospitals and 536 to the Institute of Public Health (ISP).
On Monday, May 11, the peak of tests reported in the last month by the laboratories, reaching 13,373 exams, of which 8,498, equivalent to 63.5% of the total, were reported in the MRI, followed by the Los Lagos Region with 1,670 reported PCR tests. For that day the number of infected fell to 1,197 nationwide, but 964 cases were registered in the Metropolitan Region.
According to sources in the laboratory system, “severe input problems” have been registered for the past week to carry out the PCR tests, ranging from the lack of a PCR kit to the test tubes for taking samples. On the other hand, the human capacity to process the tests in the MRI would also have reached its peak, so that supplies that went to regions had to be redirected to be diverted to the capital.
This would be one of the reasons why the number of daily tests reported in the report on this Tuesday, May 12, would have decreased, where a total of 9,283 PCR tests were reported by the laboratories, 69.2% in the RM. But the number of positives continued to rise, reaching peak of infections with 1,658 cases of coronavirus in one day, 1,392 of them were recorded on MRI. “Another situation that could have affected tangentially, is that during the weekends the number of people who go to health centers to take the test decreases, the data we see today corresponds to about 72 hours ago,” explains an ISP source.
Labs to the max
The increase in tests in the last week had focused on the private sector, which for several days outperformed tests taken by the ISP and hospitals, although the latter continue to concentrate more than half of the 303,000 tests reported.
Over the past few days, however, much of the private health network began to show specific signs of saturation. Clinics such as Integramédica, Santa María, Clinica Vespucio, Vidaintegra, Clinica Bupa, Clinica Dávila, Hospital Clinico of the University of Chile and the clinics of RedSalud de Santiago, Providencia and Vitacura, plus its subsidiaries in Iquique, Elqui, Valparaíso Rancagua and Temuco , reported almost simultaneously during the day on Tuesday that they would suspend the processing of samples due to “technical capacity problems”, “lack of supplies” and “national stock bankruptcy of a laboratory reagent”.
In the UC Christus Health Network, meanwhile, they restricted the taking of samples to the “COVID in the car” service, which is scheduled every 48 hours and to pre-surgical patients with a medical order from the same center. In a statement published on their page, they point out that there is a delay in the delivery of exams due to the increase in PCR tests in the last two weeks, which has doubled.
Despite the number of clinics that at the same time accused the saturation of the sampling system, from Minsal they ruled out, through a public statement, that there was a break in the availability of supplies at the national level, while ensuring that they had enough stock for the processing ”of the PCR test.
“In no case is there a stock break at the national level. These are specific situations, not officially reported to the Ministry of Health, focusing on private laboratories and representing 15% of the total samples that are processed in the integrated network of laboratories. We reiterate to the community that the Ministry of Health has in its public network the capacity and the necessary stock of PCR tests to continue with the sample process, ”they asserted in Minsal.
Despite the fact that said ministry in its statement maintains that the problem is regarding specific situations of some private health centers, the truth is that the day before the clinics informed their users that they were suspending the taking of samples, the Public Health Institute communicated who had also collapsed in his Viral Diseases Sub-department.
Specifically, on May 11, from the aforementioned ISP Sub-department, an email was sent informing that “in view of the exponential increase in samples that we are receiving at the ISP for the analysis of SARS-CoV-2, and given that There are already numerous private establishments in the MRI that are taking the exam, only until today, May 11, we will receive samples derived from their headquarters ”. He adds that “please do not send samples to the ISP from tomorrow, May 12, since they will be rejected from the management and sampling section.”
These suspensions and delays have also been present in the public health network. Last week, the Metropolitan Health Service informed the hospitals and Cesfam of the metropolitan network to limit the taking of samples to patients who strictly comply with the requirements of the Minsal. The regional health services reported that no more tests would be transferred to the Metropolitan Region, because the public laboratory network is saturated and that, on the contrary, samples were being sent to laboratories in nearby regions to be processed.
During the weekend, the mayor of Cerro Navia, Mauro Tamayo, denounced that the West Metropolitan Health Service had 1,800 samples queued by COVID-19, corresponding to communes in the western sector of the capital. On Saturday they sent 600 results, but the other 1,200 exams sent to the laboratory of the Lucio Córdova Hospital were rejected for “exceeding the storage time,” he explained to The counter. Consulted on the matter, the undersecretary Paula Daza indicated that “all the exams that arrive at the different laboratories, in case they are exceeding a time, are distributed to other laboratories in which the waiting time is shorter”, without giving more details.
The main risk and severity of stopping mass testing, warn sources of virology from the University of Chile, is in the case of asymptomatic people and in those cases of people who can become seriously ill, without having undergone an examination.
“The asymptomatic have long been spreading the virus in the community, and without diagnosis it has spread in the population. The unfortunate thing about all this is that, without the availability of reagents, there will be no diagnosis and, therefore, there will be no timely attention of the most severe cases, “they pointed out.
Senator Guido Girardi (PPD) warns that this decrease in testing capacity will affect MRI at its worst moment of the pandemic. “The main technical element to fight a pandemic –from my point of view–, more important than quarantine, is mass sampling, which is what really allows controlling contagions and identifying positives and treating them early. Besides, the massive testing allows to trace the contacts and identify the asymptomatic ones ”.
He explains that quarantines flatten the curves, shift contagion over time, and avoid peaksBut, “the success factor in New Zealand, South Korea and Germany is the massive testing. To compare ourselves with Germany, in Chile we should do about 20 thousand daily tests, “says the senator.
In order to overcome the lack of supplies for taking PCR samples, medical personnel from the metropolitan health services anticipate that this “could lead to an expansion of the diagnostic system for COVID-19”, such as an “Axial Tomography Computerized to the lungs plus the person’s epidemiological link. ” This system has been used in other countries where the testing capacity was surpassed by the increase in infections.
Bedding
One of the main signs that have raised the alert on the Metropolitan Region is the collapse of hospital beds, especially ICU beds, which would reach 89% of capacity in the region.
In the daily report of May 12, the most important increase in cases during the pandemic is recorded, 1,658 in total. The hospitalized patients reached 2,593 and in ICU beds they reached 604, in addition, the deceased amounted to 335 in total. The Metropolitan Region concentrates 74.5% of patients hospitalized in ICU beds nationwide, with a total of 450.
The latest version of the “National Survey on the occupation of critical units during contingency COVID-19” of the Chilean Society of Intensive Medicine, together with the Finis Terrae University, shows that of the six areas into which the Metropolitan Region is divided by service of health, only two remain below the threshold of 90% of their available ICU bed capacity: the North (77%) and the East (88%).
On May 12, the western hospital sector of the MR copied 100% of its ICU capacity, while the central zone reached 93%, the southern zone 90% and the south-eastern 98%. A situation that has led to transfer patients from the most saturated areas to private clinics, which have more beds available, indicate from the Chilean Society of Intensive Medicine (Sochimi). On the other hand, some hospital centers have had to expand their emergency capacity for respiratory diseases, such as the Hospital de Santiago Oriente, which transferred the gyneco-obstetric emergency to the CRS Cordillera Oriente, due to the increase in cases of coronavirus.
“The worrying thing about Santiago is that we have an index of 90% for the entire ICU beds region, all sectors are close to 80%. Occupancy is being very high and even in all health services in the RM,” he points out. the vice president of Sochimi, Darwin Acuña. He assures that “the fear is that the amount of demand will exceed the number of beds and fans. Currently there is still enough availability, just over 50%, but there are people and supplies that accompany the system,” he adds.
As a result of this situation and the increase in positive cases in the urban area of the Metropolitan Region, scientists and political representatives have demanded that the Minsal determine the total quarantine for the so-called Greater Santiago.
Infections in the eastern zone
Despite the fact that there is currently a large number of quarantined communes, specialists have pointed out that those in the eastern zone are an important focus of new infections. They highlight that there is a regrowth and that the lack of quarantine in these places forces people to transit from their homes in more peripheral areas to the eastern sector.
From Public Space they highlighted that based on the analysis of their latest report on the advance of the pandemic, the communes of Las Condes and Vitacura tripled the amount of contagion between the last week of April and the first week of May, while Lo Barnechea and Providencia dubbed it, like Ñuñoa, who came out of an extensive quarantine last Friday. According to the study center, the eastern part of the capital is dangerously approaching the incidence threshold by which confinement measures are decreed.
Minsal’s latest Epidemiology report is dated May 11. It can be seen that all the communes of the Metropolitan Region have maintained an increase in their infections, although the new cases were slightly lower than the record of the previous week that was published on May 8. Regarding the eastern zone, the Las Condes commune registers 738 accumulated cases. It increased in 112 new cases and in the previous one it registered an increase of 149. Vitacura has a total of 251 accumulated cases and Lo Barnechea added 41 new cases, reaching 422 accumulated.
The communes that increased the volume of new infections compared to the previous report were: La Florida, which added 247 new cases, reaching 1,071; Lo Prado, which rose to 71 new cases, totaling a cumulative total of 329; and finally, the commune of Peñalolén, which added 209 new cases, reaching 779 accumulated.
The last epidemiological report of the Ministry of Health was published on the Epidemiology page on May 12, but it is dated “May 11 Report”, since it was due to be published last Monday.
The data collected by this report, which contains the details of accumulated infections and assets broken down by region and municipality, reports on those infected since the start of the pandemic until May 10. In this way, the contagions of May 11 were left out, which –until now– represents the peak of positive results for one day, with 1,658 in the whole country and 1,392 for the Metropolitan Region.
It should be noted that, in general, this epidemiological report adds information every three days, except for the delivery on May 8, which integrated a fourth day of the report, adding the information of those infected between May 3 and 7. Instead, the report of this May 11, added the positive cases registered for three days, between May 8, 9 and 10.
The director of the Institute of Immunology of the U. of Chile, Mercedes López, states that “what is required is to carry out a total quarantine in greater Santiago, for 14 days, of the communes that are being affected by the explosive increase in cases Maintaining the flow of the communes with an outbreak towards the eastern zone is just moving the infection. “
He adds that this “implies a series of additional measures. The first is that the Government provide a salary, an economic support so that the poorest families can remain in quarantine. We also have to strengthen primary care, there must be a concern in the Territories for those people who live alone or the elderly, this work must be carried out by Primary Health Care, and sanitary residences must also be strengthened, to transfer positive COVID people who cannot quarantine in their homes. they must be under the territorial care of the health system. “
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